Second-line chemotherapy with fluorouracil, leucovorin, and irinotecan (FOLFIRI regimen) in patients with advanced small bowel adenocarcinoma after failure of first-line platinum-based chemotherapy

e15613 Background: Despite high response rates (RRs) with first-line platinum-based chemotherapy in advanced urothelial carcinoma (UCC), treatment after first-line failure remains unclear. The present multi-center phase II trial evaluated the tolerability and efficacy of weekly docetaxel as second-line chemotherapy for UCC. Methods: Between Aug 2010 and Sep 2012, 31 patients with measurable UCC, progressive after one prior platinum-based chemotherapy for advanced disease, were treated with docetaxel 30 mg/m2 on days 1 and 8. Treatment was repeated every 21 days until disease progression or unacceptable toxicity. The primary endpoints were the RR, progression-free survival (PFS), and safety. To detect a 20% difference in RR (6% vs. 26%), 28 eligible patients were required. Results: All 31 patients were previously treated with gemcitabine/platinum and had Bellmunt risk of one or more. The patients’ median age was 64 years (range, 40 to 79) and 31 (100%) patients had an ECOG performance status of 1. A total of 106 (median, 2; range, 1 to 16) chemotherapy cycles were delivered. Although fatigue (13%) and anorexia (6%) were the most frequently observed grade 3 or 4 toxicities, safety profiles were generally mild and manageable. One patient developed prolonged thrombocytopenia which led to treatment discontinuation but was resolved thereafter. In an intent-to-treat analysis, two (6%) patients achieved objective response, which maintained for 3.0 to 7.8 months. Eight patients experienced disease stabilization, resulting in a disease control rate of 32%. The median PFS and overall survival were 1.4 (95% CI, 1.3 to 1.6) and 9.6 (95% CI, 7.8 to 11.4) months, respectively. Conclusions: Second-line chemotherapy with weekly docetaxel was well tolerated but demonstrated modest antitumor activity in patient with advanced UCC who had progression after first-line platinum-containing regimen and poor prognostic factors. Clinical trial information: NCT01711112.

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Trastuzumab beyond progression in patients with HER2-positive advanced gastric adenocarcinoma: A multicenter AGEO study.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.4_suppl.94 ◽

2017 ◽

Vol 35 (4_suppl) ◽

pp. 94-94 ◽

Cited By ~ 3

Author(s):

Juliette Palle ◽

David Tougeron ◽

Astrid Pozet ◽

Emilie Soularue ◽

Pascal Artru ◽

...

Keyword(s):

Gastric Cancer ◽

Advanced Gastric Cancer ◽

Univariate Analysis ◽

Line Treatment ◽

Second Line ◽

First Line ◽

Her2 Positive ◽

Second Line Chemotherapy ◽

Platinum Based Chemotherapy ◽

Line Chemotherapy

94 Background: Trastuzumab in combination with platinum-based chemotherapy is the standard first line regimen in HER2 positive advanced gastric cancer. However, there is no data concerning continuation of trastuzumab beyond first line progression. Methods: This retrospective multicenter study include all consecutive patients with HER2 + advanced gastric or gastro-esophageal junction (GEJ) adenocarcinoma who received after progression of trastuzumab plus platinum-based chemotherapy, a second line chemotherapy with irinotecan, taxane or platinum salt, with or without trastuzumab. The prognostic variables with P values ≤0.10 in univariate analysis were eligible for the Cox multivariable regression model. Results: From August 2007 to March 2015, 104 patients were included (median age, 60.8 years; male, 78.8%; PS 0-1, 71.2%) with advanced (metastatic : 99%) gastric (45.2%) or GEJ (54.8%) cancer. All patients had received first line treatment based on trastuzumab plus fluoropyrimidine and cisplatin (n=54; 51.9%) or oxaliplatin (n=50; 48.1%). As second line chemotherapy, 67 patients (64.4%) received FOLFIRI regimen, including 19 who have continued trastuzumab; 23 patients (22.1%) received a taxane regimen (paclitaxel or docetaxel), including 12 with trastuzumab; and 14 patients (13.5%) received a platinum-based chemotherapy (different from that used in first-line), including 8 with trastuzumab. When considering all regimens of second-line chemotherapy, continuation (n=39) versus discontinuation (n=65) of trastuzumab was significantly associated with an increase on PFS (4.4 vs 2.3 months; p=0.002) and OS (12.6 vs 6.1 months; p=0.001). In multivariate Cox model (including ECOG PS, tumor grade, number of metastatic site, and second-line treatment), continuation of trastuzumab was significantly associated with longer PFS (HR=0.56; 95%CI [0.35-0.89]; p=0.01) and OS (HR=0.47; 95%CI [0.28-0.79]; p=0.004). Conclusions: This study suggests that maintenance of trastuzumab plus second line chemotherapy beyond disease progression has clinical benefit in patients with HER2 positive advanced gastric cancer. These results deserve a prospective randomized validation.

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Second-line chemotherapy by FOLFIRI in patients with advanced small bowel adenocarcinoma: A multicenter AGEO study.

Journal of Clinical Oncology ◽

10.1200/jco.2010.28.15_suppl.e14523 ◽

2010 ◽

Vol 28 (15_suppl) ◽

pp. e14523-e14523

Author(s):

A. Zaanan ◽

M. Gauthier ◽

D. Malka ◽

C. Locher ◽

J. Gornet ◽

...

Keyword(s):

Small Bowel ◽

Small Bowel Adenocarcinoma ◽

Second Line ◽

Second Line Chemotherapy ◽

Line Chemotherapy

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Microsatellite instability and mutations in BRAF and KRAS in small bowel adenocarcinoma.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e15037 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e15037-e15037

Author(s):

Vasiliki Michalaki ◽

Andreas Polydorou ◽

Theodosios Theodosopoulos ◽

George Frangulidis ◽

Nikolaos Dafnios ◽

...

Keyword(s):

Overall Survival ◽

Small Bowel ◽

Microsatellite Instability ◽

Small Bowel Adenocarcinoma ◽

Targeted Agents ◽

First Line ◽

Braf Mutations ◽

Platinum Based Chemotherapy ◽

Molecular Targeted Agents ◽

Line Chemotherapy

e15037 Background: Small-bowel adenocarcinomas (SBAs) are rare cancers with a significantly lower incidence, later stage at diagnosis, and worse overall survival than other intestinal-derived cancers. Activating KRAS and/or BRAF mutations have been identified as predictors of resistance to anti-epidermal growth factor receptor (EGFR) The aim of this study was to perform a comprehensive immunohistochemical.analysis of KRAS, NRAS, V600E BRAF mutations and microsatellite instability using a cohort of surgically resected cases in our institution. Methods: A total of 17 patients (10 males and 7 females; mean age, 56.2 years old; range, 45-75 years old) received chemotherapy due to non-curative tumor resection, unresectable tumor or post-operative recurrence. Twelve patents received fluoropirimidine and oxaliplatin based first line chemotherapy. Molecular targeted agents were administered to 15 patients, for whom it was their first- or second-line therapy. Results: KRAS mutations were found in 7 cases (41%), out of which 5 (29%) were in exons 12/13. BRAFV600E mutation was observed in 1/17 pt. Microsatellite instability was identified in 3/17pt (MSI; 18%), mainly related to a loss of expression of MLH1 protein. Univariate analysis revealed a PS of 0 (P=0.0226) and treatment with platinum-based chemotherapy (P=0.0047) were significant factors for an improved prognosis. Among the 12 patients who received oxaliplatin-based chemotherapy as a first-line chemotherapy, a PS of 0 (P=0.0255) and treatment with anti-EGFR agents (P=0.0127) were significant positive prognostic factors. Toxicities due to the molecular targeted agents were not experienced. The median overall survival time was 14.3 months (range, 3-52 months), the median DFS was 14.2 months and the median OS was 32 months. Conclusions: To date, there is no standard chemotherapy regimen for advanced SBAs and little is known about their molecular characteristics. The results of the present study indicate that oxaliplatin based chemotherapy containing molecular targeted agents is a well-tolerated and effective treatment option for SBA. A better understanding of disease biology may help to identify therapeutic targets and advance precision medicine.

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Second-line Chemotherapy for Previously Treated Metastatic Small Bowel Adenocarcinoma: A Retrospective Analysis

Anticancer Research ◽

10.21873/anticanres.15332 ◽

2021 ◽

Vol 41 (10) ◽

pp. 5147-5155

Author(s):

TAIKO NAKAZAWA ◽

YUKIYA NARITA ◽

RYOSUKE KUMANISHI ◽

TAKATSUGU OGATA ◽

YUKI MATSUBARA ◽

...

Keyword(s):

Small Bowel ◽

Retrospective Analysis ◽

Small Bowel Adenocarcinoma ◽

Second Line ◽

Second Line Chemotherapy ◽

Previously Treated ◽

Line Chemotherapy

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Prospective observational cohort study of second-line chemotherapy administration after first-line platinum-based chemotherapy for patients with advanced NSCLC in Japan (SAPPHIRE study).

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.8058 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 8058-8058

Author(s):

Kiyotaka Yoh ◽

Yasushi Goto ◽

Yoichi Naito ◽

Kazuma Kishi ◽

Yasuo Ohashi ◽

...

Keyword(s):

Observational Study ◽

Maintenance Therapy ◽

Disease Progression ◽

Advanced Nsclc ◽

Second Line ◽

First Line ◽

Second Line Chemotherapy ◽

Platinum Based Chemotherapy ◽

Line Chemotherapy

8058 Background: Maintenance therapy after first-line platinum-based chemotherapy (first-CT) is reported to be beneficial to patients with advanced non-small cell lung cancer (NSCLC). However, its impact on overall survival appears to be marginal or negligible, if those without maintenance receive active second-line chemotherapy (second-CT), which is initiated at disease progression. The purpose of this study is to investigate the proportion of second-CT administration after first-CT for patients with advanced NSCLC. Methods: From April 2010 to September 2011, 865 patients with advanced NSCLC who were initiated on first-CT at 30 institutions in Japan were enrolled in this prospective observational study. Baseline characteristics, regimens and responses to first-CT, whether or not they received second-CT, and if not, reasons for non-administration were recorded. This report describes from patients with at least 6 months of follow up. This study was supported by the Public Health Research Center Foundation CSPOR. Results: A total of 865 eligible patients with advanced NSCLC provided patient characteristics and details of first-CT. Of all patients, 70% had adenocarcinoma, 20% had squamous cell carcinoma, and 10% were positive for the EGFR mutation. At this data cut off, 225 patients were excluded from the analysis due to disease progression and loss of follow-up during first-CT, and 194 (22%) patients received maintenance therapy after first-CT. Among the 508 patients who were followed up for at least 6 months, 131 patients (26%) could not receive second-CT; the reasons were as follows: declined PS, 79 (60%); patient refusal, 28 (21%); death of any cause, 6 (5%); others, 18 (14%). Conclusions: Preliminary results of this large observational study in Japan suggested that around 20% of patients missed an opportunity to receive appropriate second-CT despite the follow-up of advanced NSCLC patients after first-CT. Further investigation is needed to elucidate the selection criteria of patients that may benefit the most from maintenance therapy, not second-CT at disease progression.

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A randomized trial of FOLFIRI versus docetaxel and cisplatin as a second-line chemotherapy after failure of first-line chemotherapy in advanced gastric cancer

Annals of Oncology ◽

10.1093/annonc/mdx261.077 ◽

2017 ◽

Vol 28 ◽

pp. iii34

Author(s):

Kil Lee Sang ◽

Seok Moon Hee ◽

Eun Kim Sung ◽

seok jang jin ◽

Young Cho Joo ◽

...

Keyword(s):

Gastric Cancer ◽

Randomized Trial ◽

Advanced Gastric Cancer ◽

Second Line ◽

First Line ◽

Second Line Chemotherapy ◽

Line Chemotherapy

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Management of neuroblastoma: a study of first- and second-line chemotherapy responses, a single institution experience

Oncology Reviews ◽

10.4081/oncol.2012.e3 ◽

2012 ◽

Vol 6 (1) ◽

pp. 3 ◽

Cited By ~ 1

Author(s):

Emmad E. Habib ◽

Amr T. El-Kashef ◽

Ezzat S. Fahmy

Keyword(s):

External Beam Radiotherapy ◽

Second Line ◽

First Line ◽

Actuarial Survival ◽

Term Survival ◽

Second Line Chemotherapy ◽

Significant Difference ◽

Grade Malignancy ◽

Chemotherapy Patients ◽

Line Chemotherapy

Neuroblastoma is a high-grade malignancy of childhood. It is chemo- and radio-sensitive but prone to relapse after initial remission. The aim of the current study was to study the results of the first- and second-line chemotherapy on the short-term response and long-term survival of children, and to further describe the side effects of treatment. Ninety-five children with advanced neuroblastoma were included in the study, divided into two groups according to the treatment strategy: 65 were treated by first-line chemotherapy alone, and 30 children who were not responding or relapsed after first-line chemotherapy were treated by second-line chemotherapy. External beam radiotherapy was given to bone and brain secondary cancers when detected. Staging workup was performed before, during and after management. Response was documented after surgery for the primary tumor. Median follow up was 32 months (range 24-60 months). Chemothe rapy was continued until toxicity or disease progression occurred, indicating interruption of chemotherapy. Patients received a maximum of 8 cycles. Toxicity was mainly myelo-suppression, with grade II-III severity in 60% of the firstline and 70% of the second-line chemotherapy patients. Median total actuarial survival was nearly 51 months for the first-line chemotherapy group and 30 months for the second-line line group, with a statistically significant difference between the two groups (P<0.01).

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